Aetna Fined $4.5 Million For Failing To Comply With Missouri Autism Law

Gov. Jay Nixon said Tuesday that Missouri had levied its largest fine ever for insurance law violations against two Aetna companies.

Nixon said Aetna Life Insurance Co. and Aetna Health Insurance Co. had agreed to pay $4.5 million for violating a 2010 state law that requires insurers to cover the diagnosis and treatment of autism spectrum disorders.

If Aetna complies with the settlement agreement, $1.5 million of the fine will be suspended, a news release from Nixon’s office said.

The settlement also requires Aetna to undertake corrective action and to be monitored for three years by the Missouri Department of Insurance.

“Missouri has a great law in effect but we’ve got insurance companies like Aetna that are trying to pedal around (it) and manipulate and hide and kind of make up stuff,” said Jennifer Smith, executive director of Autism Society The Heartland. “This is a great day for our families, because it’s saying, ‘Don’t mess with our state, don’t mess with our laws.’”

In 2012, Aetna paid a $1.5 million fine for violating the law. The news release said Aetna had failed to comply with its agreement at that time to undertake a full compliance audit.

“Aetna violated Missouri law and withheld state mandated benefits from Missouri families,” Insurance Director John M. Huff said in the news release. “Insurers must provide Missourians with benefits required under Missouri law and I will use the full extent of my regulatory authority to ensure they receive them.

“Additionally, these companies failed to comply with previous orders issued by me. This is a serious compliance issue that requires serious regulatory consequences.”

Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR.